Insurance Coordinator

Job Summary

Handle the end-to-end processing of CGHS, ECHS, and Insurance/TPA cases. Verify patient eligibility, insurance coverage, and required documents. Obtain pre-authorizations and approvals from insurance companies and government health schemes. Coordinate with consultants, nursing, billing, MRD, and other departments to collect necessary clinical documents. Prepare and submit claim documents within the stipulated timelines. Ensure accurate billing and documentation as per CGHS/Insurance guidelines. Follow up with insurance companies and TPAs for claim approvals, queries, and settlements. Resolve claim rejections, deficiencies, and pending cases. Maintain proper records of cashless approvals, reimbursements, and claim status. Coordinate with patients and attendants regarding insurance procedures and required documentation. Ensure compliance with CGHS, TPA, IRDAI, and hospital policies. Prepare daily, weekly, and monthly MIS reports related to insurance claims. Maintain confidentiality of patient information and claim records. Support internal and external audits related to insurance and government schemes. Perform any other duties assigned by the department head.

Responsibilities

• Handle the end-to-end processing of CGHS, ECHS, and Insurance/TPA cases.
• Verify patient eligibility, insurance coverage, and required documents.
• Obtain pre-authorizations and approvals from insurance companies and government health schemes.
• Coordinate with consultants, nursing, billing, MRD, and other departments to collect necessary clinical documents.
• Prepare and submit claim documents within the stipulated timelines.
• Ensure accurate billing and documentation as per CGHS/Insurance guidelines.
• Follow up with insurance companies and TPAs for claim approvals, queries, and settlements.
• Resolve claim rejections, deficiencies, and pending cases.
• Maintain proper records of cashless approvals, reimbursements, and claim status.
• Coordinate with patients and attendants regarding insurance procedures and required documentation.
• Ensure compliance with CGHS, TPA, IRDAI, and hospital policies.
• Prepare daily, weekly, and monthly MIS reports related to insurance claims.
• Maintain confidentiality of patient information and claim records.
• Support internal and external audits related to insurance and government schemes.
• Perform any other duties assigned by the department head.

Qualifications

• Bachelors Degree in Hospital Administration, Healthcare Management, Commerce, or any relevant discipline.
• Certification in Hospital Administration or Medical Insurance is an added advantage.

Experience

• 1 3 years of experience in CGHS, ECHS, TPA, Insurance Processing, or Hospital Billing.
• Experience in a multispecialty or tertiary care hospital is preferred.
• Freshers with relevant healthcare knowledge may also be considered.

Skills

• CGHS
• ECHS
• TPA
• health insurance claim processes
• hospital billing procedures
• medical terminology
• documentation
• claim-processing
• Hospital Information Systems (HIS)

Specialisation

• 1 3 years of experience in CGHS
• Insurance Processing
• or Hospital Billing. Experience in a multispecialty or tertiary care hospital is preferred. Freshers with relevant healthcare knowledge may also be considered.

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